從美國急症執業護理師看臺灣專科護理師之發展

The Future Development of Nurse Practitioner in Taiwan – What can we Learn from the Experience of Acute Care Nurse Practitioner in U.S.A.

台灣的專科護理師角色執行已十多年，直到2005年才正名為專科護理師(nurse practitioner, NP)。NP是護理角色的延伸，是護理與醫學的統合，更是之間的橋樑，因此角色的定位很重要。而目前NP角色執行不是偏向醫生助理(physician assistant, PA)，就是臨床護理專家(clinical nurse specialist, CNS)，混淆不清的名稱讓醫療界，甚至專科護理師本身都不了解此角色的定位。台灣專科護理師角色像美國的急症執業護理師(acute care nurse practitioner, ACNP)，ACNP是NP角色之一，執行二、三級照護。台灣醫療界普遍專科化，大多數專科護理師訓練過程中缺乏執行初級照護(primary care)的基礎，因此發生良莠不齊等問題，此外還有職稱及專業角色不明確、缺乏支持與職權、缺乏教育培育及臨床師資等困境。因此希望經由對美國ACNP的介紹，增加對這角色的了解，以促進此角色的發展。

The role of nurse practitioner has been carried out in Taiwan for more than 10 years; we rectified the nurse specialist to nurse practitioner (NP) in 2005. The role of NP should be an expansion of nursing care--the integration and bridge between nursing and medicine. In some ways, it is like the role of physician assistant (PA). In other ways, it is just like the role of clinical nurse specialist. Actually, the role of nurse practitioner in Taiwan is somewhat like the role of acute care nurse practitioners (ACNP) in the United States--they carry out secondary and tertiary care. The ACNP is more comprehensive level of NP. But due to the lack of primary care education, supporting systems, authority, and uncertainty of professional role, the NP system in Taiwan has to be refined to meet the future challenge. Through proper identified, educational and qualified system, we can precisely define the role of NP and provide a better medical service. We hope this article, by reviewing the ACNP system in the United States, will be helpful for the future development of NP in Taiwan.